Estimation of glucose carbon recycling and glucose turnover with [U-13C] glucose

To estimate "true" rate of glucose production, as well as glucose carbon recycling in humans, a mass spectrometric method with [U-13C]glucose as tracer was developed. Because the opportunity for the uniformly labeled glucose, [13C6]glucose, to recycle back as [13C6]glucose is negligible, the true glucose production rate was obtained by measuring the plasma isotope enrichment of [13C6]glucose with chemical ionization mass spectrometry. In contrast, when the isotopic enrichment of C-1 of glucose was measured by enzymatic decarboxylation and ratio mass spectrometry, the "apparent" glucose production including carbon recycling was obtained. The difference between the two rates was the extent of glucose carbon recycling. [U-13C]glucose was administered as primed constant-rate infusion to six normal healthy adult subjects. Rates of glucose turnover were calculated from tracer dilution by applying steady-state kinetics. The true rate of glucose production estimated by the present method was 2.02 +/- 0.19 mg X kg-1 X min-1 (mean +/- SD). After an overnight fast, glucose carbon recycling contributed from 3 to 26% of the total glucose production rate. Use of stable isotopes and mass spectrometric technique permits estimation of important parameters of glucose metabolism without resorting to multiple tracers and at the same time preventing the risk of radiation.